Abstract
Background: Energy produced during mechanical ventilation has been es¬tablished as a contributor to mortality in acute respiratory distress syndrome (ARDS) patients, elucidated through ventilator-induced lung injury (VILI). How¬ever, the potential association between strain energy, an engineering-based concept, and the risk of VILI remains unexplored. Objectives: This study aims to investigate the correlation between strain en¬ergy and alveolar overdistension and the relationship between strain energy and single-breath mechanical power (MP) calculated by a simplified formula in patients with ARDS. Methods: A prospective observational study will be conducted on moderate to severe ARDS patients under sedation and paralysis. We will gradually reduce positive end-expiratory pressure (PEEP) by two cmH2O every two minutes from 20 to 8 cmH2O in pressure-controlled ventilation mode. During decremental PEEP titration, patients would be monitored simultaneously for esophageal pressure and electrical impedance tomography (EIT). Data gathered from the mechanical ventilator and EIT during the decrementing PEEP titration were fo¬cused on seven PEEP levels: 20, 18, 16, 14, 12, 10, and 8 cmH2O, providing a dataset of 7 events per patient for analysis. Strain energy and single-breath MP were calculated from ventilator parameters, while EIT provided data on alveolar overdistension. Hypothesis: We hypothesized that strain energy and single-breath mechanical MP correlate with alveolar overdistension in ARDS patients. Conclusions: This study aims to assess the correlation between strain energy and alveolar overdistension, as well as the correlation between strain energy and single-breath MP in ARDS patients. Ethics and dissemination: The study protocol has been approved by the fac¬ulty of medicine ethics committee, Ramathibodi Hospital, Mahidol University (COA MURA2023/718). Trial registration: TCTR20240320001
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